Definition
A.Eczema-like inflammation of the lower extremities associated with impairment of the vascular–lymphatic system.
Incidence
A.Happens to 6.2% of people equal to or older than 65 years old.
Pathogenesis
A.Caused by back flow of veins with leaking hemosiderin from congested blood vessels.
Predisposing Factors
A.Decreased mobility.
B.Impairment of vascular–lymphatic system.
1.Venous insufficiency.
2.Lymphedema due to impaired lymphatic drainage.
3.Lymph node resection.
4.Prior radiation treatments to affected area.
C.Chronic comorbidity conditions.
1.Malnourishment, obesity, diabetes, chronic kidney disease, chronic liver disease, alcohol abuse.
2.Immunosuppression (HIV, cancer, taking immunosuppressive agents).
3.Tinea pedis or other dermatitis-affected skin integrity.
Subjective Data
A.Common complaints/symptoms.
1.Itch, erythema.
2.Dark patches.
3.Dry skin.
4.Sometimes swelling.
B.Common/typical scenario.
1.Chronic rash that started on one lower leg at ankle and now is on both.
2.Sometimes itchy.
3.Happened over several weeks to months.
C.Family and social history.
1.Smoker.
D.Review of systems.
1.Usually negative.
FIGURE 15.4 Example of stasis dermatitis.
Source: Lyons, F., & Ousley, L. (2015). Dermatology for the advanced practice nurse. New York, NY: Springer Publishing Company.
Physical Examination
A.Bronze to erythematous dry patch of skin with or without scale.
B.On bilateral extremities, worst on ankles (see Figure 15.4).
C.Mild to moderate swelling.
D.Rarely blisters, necrosis.
E.If palpate warmth, need to rule out deep vein thrombosis (DVT).
F.If exquisite tenderness and rapid progression occurs, rule out necrotizing fasciitis.
Diagnostic Tests
A.Culture: Usually negative, but can have secondary infection when purulent discharge is present. Majority cannot be cultured unless abscess present for incision and drainage.
B.Biopsy: Poor healing and low diagnostic yield.
C.Doppler ultrasound (if suspect DVT).
Differential Diagnosis
A.Cellulitis.
B.Lipodermatosclerosis.
C.DVT.
D.Venous ulcer.
E.Insect bite reaction.
F.Contact dermatitis.
G.Skin cancer (squamous cell carcinoma).
H.Erysipelas.
I.Necrotizing fasciitis.
Evaluation and Management Plan
A.General plan.
1.Maintenance skin integrity.
2.Increase venous return.
B.Patient/family teaching points.
1.Elevate legs daily for 30 minutes four to five times daily.
2.Compression stockings during daytime activities.
C.Pharmacotherapy.
1.Topical steroids: Triamcinolone 0.05% cream/ointment twice daily for 2 weeks.
D.Discharge instructions (if standard accepted guidelines exist please use discharge template).
Follow-Up
A.Dermatology.
B.Follow-up in 1 to 3 months.
Consultation/Referral
A.If persists or worsens, consult/refer to dermatology.
Special/Geriatric Considerations
A.Elderly populations will have more difficulty with staying active to prevent blood and fluid from pooling in lower extremities.
Bibliography
Buttaro, T., Trybulski, J., Polgar-Bailey, P., & Sandberg-Cook, J. (2013). Primary care—E-book (4th ed.). St. Louis, MO: Elsevier.
Fitzpatrick, J., & Morelli, J. (2011). Dermatology secrets plus (4th ed.). Philadelphia, PA: Elsevier.
Habif, T. (2011). Skin disease (pp. 160–163). Edinburgh, Scotland: Saunders/Elsevier.
Lyons, F., & Ousley, L. (2015). Dermatology for the advanced practice nurse. New York, NY: Springer Publishing Company.
Yalçin, B., Tamer, E., Toy, G. G., Oztaş, P., Hayran, M., & Alli, N. (2006). The prevalence of skin diseases in the elderly: Analysis of 4099 geriatric patients. International Journal of Dermatology, 45(6), 672–676. doi:10.1111/j.1365-4632.2005.02607.x